On Cloud Nine-One-One?: Vaping safety

Unless you’ve been avoiding the news (which is honestly understandable these days), you’ve probably heard recently about the dangers of vaping. This week we saw the sixth confirmed death from the mysterious vape-related illness that seems to be sweeping the nation. Although we have yet to see any cases in RI, the RI Department of Health reports that 1 in 5 RI teens use “e-cigs” like the popular Juul, which resembles a USB-device. Likewise, there has been an increase in demand both in the legal and underground marijuana markets for vape pens, which offer a discreet and convenient method for vaping cannabis concentrates. Even if you don’t partake yourself, chances are that you or your kids know someone who vapes regularly, and the news reports can be pretty alarmist (shocker, I know). So what do we actually know about vaping, and why is it making people sick?

What Is Vaping?

Vaping refers to the practice of using a device that vaporizes a liquid containing either nicotine or cannabis extracts (usually not both), often blended with other solvents that help to dissolve and deliver the drug through inhalation. Although scientists haven’t yet pinpointed a key ingredient common to all of the current cases of illness, many believe that these carrier oils may be the culprit. Among the various oils, cutting agents and chemicals found in vaping liquid, there have also been reports of pesticides, carcinogens and heavy metals. It doesn’t help that there are no meaningful regulations of these products, and that none of the e-cigs currently on the market have been systematically reviewed by the FDA.

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Vaping was invented decades ago, but emerged in its modern form in the mid-2000s as a safer alternative to combusting and inhaling tobacco or cannabis products. “E-cigarettes” have been marketed as a way for smokers to transition away from cigarettes altogether, while some cannabis users prefer vaping flower or concentrates as a gentler and more therapeutic alternative to smoking traditionally.

What Are the Risks?

The mysterious pulmonary illness popping up around the country appears to be an inhalation injury, likely resulting from the body reacting to a specific ingredient in the vape liquid. The symptoms, including shortness of breath, fatigue, chest pain and vomiting, have been associated with an illness known as lipoid pneumonia and are caused when carrier oils are vaporized at high temperatures and then recondensed in the lung tissue, damaging cells and affecting the lungs’ ability to exchange gases. That can decrease the amount of oxygen that gets to a person’s bloodstream, and cause their lungs to fill with fluid. One such oil has been identified by an FDA investigation as vitamin E acetate, an oil derived from vitamin E that has been found to be a common ingredient in many of the victims’ cases. Commonly used as a vitamin supplement and in topical skin treatments, vitamin E acetate is safe to swallow, but turns out to be dangerous when vaporized, as it coats the lungs with oil and leads to the pneumonia-like illness.

What Can I Do to Protect Myself?

Because of a lack of oversight, there is always a risk in consuming an unregulated product. Most of the recent victims had been using THC vape cartridges purchased on the underground market, but many reported using both cannabis and nicotine vapes. According to Dr. Scott Gottlieb, the former commissioner of the Food and Drug Administration, “This is probably going to be associated with illegal products. It’s not like the major manufacturers have suddenly changed their ingredients,” he said. “It’s probably something new that has been introduced into the market by an illegal manufacturer, either a new flavor or a new way to emulsify THC that is causing these injuries.” Until we have more information on the dangers posed by certain vape ingredients, or stricter regulations on their production, consumers should use vapes at their own risk. The FDA and the CDC have issued a common sense warning: “If you are concerned about these specific health risks, consider refraining from the use of e-cigarette products.”

In the most recent news, the Trump administration and the FDA would like to ban flavored e-cigarettes, leaving only tobacco-flavored vape juice available for purchase in stores or online. Flavors like mint, mango and other fruits make up 80% of the $9 billion total sales of Juuls in the US, and many believe that these flavors are deliberately marketed toward young people, although they are enjoyed by vapers of all ages. A Juul spokesman recently said that the company strongly agrees with “aggressive category-wide action on flavored products. We will fully comply with the final FDA policy when effective.” In any case, we already know that 8 million adults and 5 million children, or more than 25% of high school students in the US, have reported using e-cigs regularly. The time is now to start researching and regulating these popular devices so that accurate information can be made available to healthcare professionals and the public, and proper harm reduction practices can be put in place. So, is vaping dangerous? While evidence points to vaping as a safer alternative to smoking, until we have all of the information, the long-term risks of vaping remain to be seen.